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Effect of a brief emergency medicine education course on emergency department work intensity of family physicians

Vaillancourt S, Schultz SE, Leaver C, Stukel TA, Schull MJ. CJEM. 2013; 15(1):34-41.

Background — Recently, many Canadian emergency departments (EDs) have struggled with physician staffing shortages. In 2006, the Ontario Ministry of Health and Long-Term Care funded a brief "emergency medicine primer" (EMP) course for family physicians to upgrade or refresh skills, with the goal of increasing their ED work intensity. The researchers sought to determine the effect of the EMP on the ED work intensity of family physicians.

Methods — A retrospective longitudinal study was conducted of the ED work of 239 family physicians in the 2 years before and after a minimum of 6 months and up to 2 years from completing an EMP course in 2006 to 2008 compared to non-EMP physicians. ED work intensity was defined as the number of ED shifts per month and the number of ED patients seen per month. The researchers conducted two analyses: a before and after comparison of all EMP physicians and a matched cohort analysis matching each EMP physician to four non-EMP physicians on sex, year of medical school graduation, rurality, and pre-EMP ED work intensity.

Results — Postcourse, EMP physicians worked 0.5 more ED shifts per month (13% increase, p =  0.027). Compared to their matched controls, EMP physicians worked 0.7 more shifts per month (13% increase, p =  0.0032) and saw 15 more patients per month (17% increase, p =  0.0008) compared to matched non-EMP physicians. The greatest increases were among EMP physicians who were younger, were urban, had previous ED experience, or worked in a high-volume ED. The effect of the EMP course was negligible for physicians with no previous ED experience or working in rural areas.

Conclusion — The EMP course is associated with modest increases in ED work intensity among some family physicians, in particular younger physicians in urban areas. No increase was seen among physicians without previous ED experience or working in rural areas.

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Keywords: Emergency medical services Primary care/clinical practice Medical education and training